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Don't Skip The Preparticipation Physical Exam
by Dev Mishra, August 17th, 2012 3:09AM

TAGS:  high school boys, high school girls, youth boys, youth girls


By Dev K. Mishra, M.D.

The "sports physical," formally known as the preparticipation physical exam (PPE), is an important part of an athlete’s summer regimen. Most high schools require a preseason physical exam but one of the ways many young athletes can fall through the cracks is with competitive club sports that typically have absolutely no requirement for the PPE.  My strong advice to club sport athletes: don’t skip the preparticipation physical exam.

What Is A Sports Physical?
The PPE is a screening examination that is given to athletes before the start of a sports season. Objectives of the preparticipation evaluation include:

* Screening for life-threatening or permanent conditions, such as heart conditions or asthma.

* Evaluation and screening of concussion risk.

* Screening for treatable or avoidable injuries, such as muscle or joint injuries.

* Opportunity for a young athlete to interact with a knowledgeable physician. A simple conversation might bring up an issue that could easily be solved and prevent future issues.

The exact requirements, including the frequency of subsequent PPEs, (yearly, every two years, or only before the first year of competition) vary among schools, states, and organizations. The PPE can be performed by the athlete’s primary care physician, a sports physician, or by a coordinated medical team with “stations” for different parts of the exam.

What Happens If Problems Are Found
Most athletes will be cleared for full participation after the PPE.  But some athletes will need further testing or evaluation by other specialists prior to clearance. In rare cases where participation is restricted, efforts are made to find an alternative sport at which the athlete can participate. For example, an athlete with a spine injury would not be cleared for tackle football but may be allowed to swim or run track.

There are several conditions that may unfortunately result in disqualification from some or all sports, including cardiac, neurological, musculoskeletal, infectious, skin, and pulmonary issues. Other general conditions that might require special consideration regarding participation include sickle cell trait, diabetes, loss of a paired organ, eating disorders and epilepsy. Cardiac issues are especially important because they are the most likely to lead to sudden death in athletes.

A general principle is that any athlete who has had any cardiac symptoms such as chest pain, shortness of breath, light-headedness, syncope (passing out), or palpitations (irregular heart beat) should have a thorough medical work-up before being cleared for sports.

When I’m doing a PPE I sometimes find that a young athlete will try to hide an ongoing issue out of fear that they will be automatically disqualified. From a practical standpoint total disqualification is rare, but more commonly we may find issues that need correction before full clearance. While that might take some time to be corrected the end result is a better, healthier athlete able to compete at their best.

(Dr. Dev K. Mishra is the creator of the injury management program for coaches. He is an orthopedic surgeon in private practice in Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley. This article first appeared on

1 comment
  1. daren moon
    commented on: August 17, 2012 at 10:21 a.m.
    A couple years ago my son who was 16 at the time was diagnosed with Wolff-Parkinson-White syndrome during a PPE. While it excluded him from high school sports that year, he is now cleared after undergoing an ablation.

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